Patient Access Representative II 12 HR-KSMC
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The Patient Access Representative II is a unique role within the Kaiser Permanente Health System environment. The Patient Access Representative II welcomes the patient into the care delivery setting and initiates the administrative systems that will lay the groundwork for the patients clinical care as well as the financial documentation. The Patient Access Representative II is responsible for ensuring a complete and accurate patient admission/registration. Responsibilities include but are not limited to: collecting pertinent registration data, performing functions such as limited insurance eligibility and benefits verification, point of service cash collection, based on established manual or technological protocols, and completion of documentation necessary for the expedient registration/ admission of patients according to organizational policy and procedures and federal/state/regulatory requirements. Obtaining inpatient bed assignments and processes inpatient admission, including direct admit, to include following patient identification protocols and completion of necessary documentation. Performing bed management coordination functions within the bed control arena. Refers patients to Financial Counselors for Medical Financial Assistance. Answers and/or refers questions received from patients, visitors, staff as appropriate. Performs various related cash handling procedures per SOX control regulations. This position acts as an ambassador to ensure a patient friendly experience. The Patient Access Representative II has knowledge of state and federal regulations governing patient healthcare encounters and assures compliance. The Patient Access Representative II facilitates the patient and family care experience and aids them in understanding the Kaiser Permanente Healthcare System facilities and routines. The Patient Access Representative II works closely with both the financial team (Patient Business Services and the payor(s)) and the clinical team (Utilization Management, Emergency Department, HAS/PFC, nursing, physicians, etc) to ensure the optimum patient experience, accurate registration, maximum cash flow and reimbursements for the system. This position is an intermediate level position that requires a professional service-oriented individual with strong organizational skills working under limited supervision. The work environment at times can be stressful, pressured, or hostile. This position works on the front line with constant patient interaction in high volume registration areas and the Emergency Departments. Work situations are varied and require an individual with the ability to respond to patients and families with compassion, respect, and understanding. This position requires strong organization skills, prioritization, good judgment, diplomacy, and independent thinking. Internal contacts include physicians, staff and management throughout the organization, including, but not limited to, Patient Business Services, Patient Access Representative III, Utilization Management, Patient Flow Coordinators/HAS, and Health Information Management. External contacts include patients, families, community physicians, and outside organizations such as representatives from government agencies, allied hospitals and insurance carriers. Independent decision-making is required in daily routine functions. Major decisions are subject to review and approval. Staff members in this position may perform all, or a combination of the duties described depending upon their assigned work area and the specific needs of the department.
- Registration: Greets and registers patients for various medical services in the hospital setting potentially in a 24 hour, 7 day a week environment and in a highly active fast paced setting such as the Emergency department. Pre-registers patients where applicable. Completes comprehensive bedside or telephone interviews with Patient, relative, or their representative to obtain pertinent demographic information, insurance data and/or third party liability information. Performs complex eligibility verification and resolves any discrepancies, identifies need for financial assistance recommendation and application, referring to the Financial Counselor where necessary. Verifies the patient demographic and insurance information with the patient consistent with CMS regulations, the National Registration Standards and regional policies. Verifies Insurance Eligibility and Benefits (include policy limitations) for all payers prior to or upon admission to the hospital, using computer based verification programs, as available.. For Medicare, using approved system to determine eligibility, co-insurance days, lifetime reserve days etc. and notify Utilization Management when a patient will be utilizing his/her lifetime reserve days. For other governmental payers such as Medicaid, use the states approved system to check for eligibility and benefit information. Uses problem-solving skills to verify patient identification through patient name, spouse names, SSN, DOB and address in order to identify and minimize duplicate medical records. Interview patient to obtain/determine appropriate insurance carrier and identifies, verifies, and inputs Other Coverage Information (OCI), primary, secondary, and tertiary payers for services provided. Completes registration requirements for professional billing into HealthConnect for patients receiving services at northwest plan hospitals. Performs registration function for all patient class and clinical services. Completes admission protocol for allied hospitals. Maintains recurring/series patient files and preforms co-preadmission functions. Maintains and completes pre-admission processes for surgical admission in preparation for date of service.
- Revenue Collection: Determines and collects cost-shares, and partial payments for services to be received. Enter/verify payments in the computer, close cash drawers, count currency, checks, and credit card payments at the end of each shift, and create deposits per cash handling policies. Provides patient liability information and collects the point of service cash from patients based on guidelines and/or systems provided by the department, including but not limited to: co-payments, deductibles, co-insurance, deposits, outstanding balances. Communicate to the patient the Northwests policy on payment of services or prepayment when significant patient liabilities are identified. Refers, as appropriate, to financial counselors. Provides price estimates to physicians, insurance and other third parties as requested. Interacts with Patient Business Services/Membership Services personnel regarding status of accounts as necessary to respond to questions/concerns related to registration requirements. Documents all activity pertaining to patients account in the system.
- Appointing: May schedule and/or cancel right type of appointment based on members needs and regional protocol. May provide intermittent coverage for bed control in the hospital setting. If applicable, makes return appointments and referrals.
- Regulatory/Organizational Compliance: Completes regulatory or policy required forms, to include payor requirements such as Medicare, L & I requirements and some commercial payors, and obtains all necessary signatures via mail, pre-admit, pre-op visit or upon admission/ registration. Makes copies of patient identification, insurance information and other related forms and documents, electronically scan capture where appropriate. Fully understands and adheres to the rules and regulations of Medicare, Medicaid, Managed Care and Commercial payers regarding referrals, preauthorization and pre-certification requirements. Is knowledgeable and maintains compliance with CMS by accurately completing Medicare Secondary Payer screening information to determine primary payor. Receives physician orders and, if applicable, performs medical necessity check using automated system. Interprets basic healthcare systems regulations and policies for patients and patient families consistent with the defined scope of work. Knowledge of MOAB training requirements for managing aggressive behavior. Maintains an understanding of HIPAA privacy and security regulations with respect to Patient confidentiality and regulations that govern system use for patient registration requirements. Maintains a full understanding and adherence to EMTALA regulations and the relevance for patient registration and patient liability collection in the Emergency Department.
- General Services: May provide coverage for bed control during lunch, breaks, vacations. Stocks appropriate forms and supplies; takes out used supplies. Demonstrating responsibility in handling supplies and equipment in a cost-effective manner and according to standards such as policies, procedures, and infection control guidelines. Assist patients by providing specialty phone numbers, facility directions and office layouts; directing to other departments and administrative services for further information, for example (but not limited to) Membership Services, Dental and Pharmacy. Escorting patients to area of service. Provide Notary services to patients, members and their family. Initiates safekeeping and return of Patients valuables in accordance to hospital policy when required. Provides information assistance to Patients, visitors, and the public regarding general hospital policies and procedures. Interacts with patients physician regarding status of hospital account/registration issues and refers as needed. Provides patients demographic information/insurance plan updates to physician offices or other medical services, such as EMT services where appropriate. Responsible for maintaining records during system downtime and performs recovery processes. Maintains accurate statistical records of departmental activities as needed, for data gathering within the UBT work teams. Performs all other duties as assigned consistent with job description.
- Two (2) year of healthcare financial setting to include one (1) hospital setting Including one (1) year of office environment customer service OR two (2) years of post high school related education OR combination of education and experience.
- High School Diploma or General Education Development (GED) required.
- Basic Life Support
- Notary Commission Certificate (Oregon)
- Healthcare Access Associate Certificate
- Medical Terminology Certification
- Excellent communication skills with all types of individuals.
- Excellent organizational and written skills, flexibility and ability to switch tasks frequently.
- Ability to type minimum 35 wpm with above average accuracy.
- Previous experience with cash handling required.
- Must obtain cross training in all areas of the Patient Access Department (Admitting, Bed control, Central Check in, Labor and Delivery, Residential Treatment Center and ED) AND be willing to work in all areas.
- Ability to operate CRT, IBM compatible PC, Windows, such as MS Word/Excel, copier, fax, phone, and headset.
- Job requires continuous reading skills and the ability to handle a heavy volume of work.
- Knowledge of medical terminology, diagnostic related groupings (DRGs/MSDRGs), diagnosis code (ICD-9-CM) and common procedure terminology (CPT 4/APC) codes to determine benefits and estimate service cost.
- Knowledge of Medicaid, Medicare, and other government and insurance/payor requirements.
- Knowledge of State and Federal regulations governing healthcare encounters, such as HIPAA, State workers compensation, third party liability for accidents, EMTALA and etc.
- Knowledge of and skill in the use of automated Patient care systems for admissions, registration, and basic medical records functions.
- Knowledge of state and federal regulations regarding funding resources.
- Knowledge of organizations and/or facility based billing systems.
- Knowledge of department procedures and established confidentiality policies.
- Knowledge of communication techniques with ability to listen actively and respond to fellow employees/customers in a timely, competent manner both verbally and non-verbally.
- Previous hospital or ambulatory clinic registration experience.
- Previous experience with EPIC applications preferred.
- One/Two (1/2) years of higher education preferred.